Current status of extracorporeal shock wave lithotripsy in urinary lithiasis.Authors:
Jose Gregorio Pereira-Arias, Mikel Gamarra-Quintanilla, Luis Felipe Urdaneta-Salegui,
Jorge Alberto Mora-Christian, Andrea Sánchez-Vazquez, Ander Astobieta-Odriozola y
Arch. Esp. Urol. 2017; 70 (2): 263-287
Vol. 70, Number. 2, March 2017
Over the last decade, urinary lithiasis`
prevalence has dramatically increased due to diet and
lifestyle changes, growing 10,6% and 7,1% in men and
women respectively. Extracorporeal shock wave lithotripsy
has lost relevance in current practice due to endoscopic
device development and unpredictability of results.
Instrument miniaturization is leading to an increase of
the percutaneous approach of increasingly smaller
stones, while most flexible ureteroscopes durability and
digitalization has allowed urologists to address larger
So that, decision algorithm is now impossible to define,
but what is clear is that ESWL has declined worldwide.
Can it disappear as a urinary lithiasis treatment
modality? If we don´t improve appropriate candidate
selection and optimize disintegration efficiency,
guidelines are going to replace the more “boring”
ESWL by popular and more attractive endoscopes.
Shock wave technology has evolved in the last two
decades, however lithotripsy fundamental principle
has not changed. ESWL has passed the test of time
and centers dedicated to stone treatment should have
a lithotripter in order to offer an appropriate balance
in different options for different clinical situations.
New developments will be focused on improvements
in location (in-line navigation systems; Vision track
system) and automatic ultrasound location on a robotic
arm; monitoring and stone fixation, implementation of
different focal sizes with new acoustic lenses, multitask
working stations that allow endourological approach,
coupling control (avoiding microbubbles) and low cost
devices for different applications. On the other hand,
optimizing outcomes by: slower pulse rates, ramping
strategies and patient selection with soft stones, short
stone-skin distance, low BMI and favorable collecting
system anatomy, allow us to achieve better outcomes
in shock wave treatments. SWL still represents a unique
non invasive method of stone disease treatment with
no anesthesia and low complication rates; and a high
proportion of stones could still be treated with shock
waves and remains among patient`s first options.
This update objective has been to review the evolution,
identify shock wave new developments and clarify their
impact on our daily practice in urinary stones treatment.
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